# GRANDGEN, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Devenu Medical Rejuvenation Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326351651
- **Authorized official:** MR. JON FULCHER (PRESIDENT)
- **Authorized official phone:** (402) 445-6173

## Contact information

- **Practice address:** 9802 NICHOLAS ST, SUITE 305, OMAHA, NE 68114-2167
- **Practice address phone:** (402) 397-2300
- **Practice address fax:** (402) 397-2303
- **Mailing address:** 9802 NICHOLAS ST, SUITE 305, OMAHA, NE 68114-2167
- **Mailing address phone:** (402) 397-2300
- **Mailing address fax:** (402) 397-2303

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | 23224 | IA | Yes |

## Other

- **Enumeration date:** 07/15/2010
- **Last updated:** 07/15/2010